Provider Demographics
NPI:1629094248
Name:STANTON, LORI (CRNA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1984 PEACHTREE RD NW
Mailing Address - Street 2:STE 515
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5219
Mailing Address - Country:US
Mailing Address - Phone:404-351-1754
Mailing Address - Fax:404-351-7121
Practice Address - Street 1:1640 AIRPORT RD NW
Practice Address - Street 2:STE 110
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7038
Practice Address - Country:US
Practice Address - Phone:678-202-2074
Practice Address - Fax:770-590-1442
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2021018041367500000X
MO2016015968367500000X
GARN131489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA906922040Medicaid
GA906922040Medicaid
43BBBHRMedicare ID - Type Unspecified